|
STENT PERCUFLEX PLUS 4.8 X 24 M0061752520
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.76 |
| Max. Negotiated Rate |
$4,768.00 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.12
|
| Rate for Payer: Aetna Managed Medicare |
$333.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$774.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$572.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.76
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,096.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.04
|
| Rate for Payer: Health EOS Commercial |
$1,060.88
|
| Rate for Payer: HFN Commercial |
$1,096.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: NAPHCARE Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.64
|
| Rate for Payer: Quartz Beloit One Network |
$584.08
|
| Rate for Payer: Quartz Commercial |
$774.80
|
| Rate for Payer: Quartz Medicare Advantage |
$715.20
|
| Rate for Payer: The Alliance Commercial |
$4,768.00
|
| Rate for Payer: WEA Trust Commercial |
$655.60
|
| Rate for Payer: WPS Commercial |
$882.91
|
|
|
STENT PERCUFLEX PLUS 4.8 X 24 M0061752520
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.08 |
| Max. Negotiated Rate |
$1,096.64 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.76
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,096.64
|
| Rate for Payer: Health EOS Commercial |
$1,060.88
|
| Rate for Payer: HFN Commercial |
$1,096.64
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: NAPHCARE Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.64
|
| Rate for Payer: Quartz Beloit One Network |
$584.08
|
| Rate for Payer: Quartz Commercial |
$715.20
|
| Rate for Payer: WEA Trust Commercial |
$655.60
|
| Rate for Payer: WPS Commercial |
$882.91
|
|
|
STENT PERCUFLEX PLUS 4.8 X 26 M0061752530
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5415129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.48 |
| Max. Negotiated Rate |
$6,364.00 |
| Rate for Payer: Aetna Commercial |
$1,431.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,368.26
|
| Rate for Payer: Aetna Managed Medicare |
$445.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,034.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$795.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$763.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.23
|
| Rate for Payer: Cash Price |
$477.30
|
| Rate for Payer: Cigna Commercial |
$1,463.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$890.32
|
| Rate for Payer: Health EOS Commercial |
$1,415.99
|
| Rate for Payer: HFN Commercial |
$1,463.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,193.25
|
| Rate for Payer: Multiplan Commercial |
$1,272.80
|
| Rate for Payer: NAPHCARE Commercial |
$954.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,463.72
|
| Rate for Payer: Quartz Beloit One Network |
$779.59
|
| Rate for Payer: Quartz Commercial |
$1,034.15
|
| Rate for Payer: Quartz Medicare Advantage |
$954.60
|
| Rate for Payer: The Alliance Commercial |
$6,364.00
|
| Rate for Payer: WEA Trust Commercial |
$875.05
|
| Rate for Payer: WPS Commercial |
$1,178.45
|
|
|
STENT PERCUFLEX PLUS 4.8 X 26 M0061752530
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5415129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.59 |
| Max. Negotiated Rate |
$1,463.72 |
| Rate for Payer: Aetna Commercial |
$1,431.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,368.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.23
|
| Rate for Payer: Cash Price |
$477.30
|
| Rate for Payer: Cigna Commercial |
$1,463.72
|
| Rate for Payer: Health EOS Commercial |
$1,415.99
|
| Rate for Payer: HFN Commercial |
$1,463.72
|
| Rate for Payer: Multiplan Commercial |
$1,272.80
|
| Rate for Payer: NAPHCARE Commercial |
$954.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,463.72
|
| Rate for Payer: Quartz Beloit One Network |
$779.59
|
| Rate for Payer: Quartz Commercial |
$954.60
|
| Rate for Payer: WEA Trust Commercial |
$875.05
|
| Rate for Payer: WPS Commercial |
$1,178.45
|
|
|
STENT PERCUFLEX PLUS 4.8 X 28 M0061752540
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.76 |
| Max. Negotiated Rate |
$4,768.00 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.12
|
| Rate for Payer: Aetna Managed Medicare |
$333.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$774.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$572.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.76
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,096.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.04
|
| Rate for Payer: Health EOS Commercial |
$1,060.88
|
| Rate for Payer: HFN Commercial |
$1,096.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: NAPHCARE Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.64
|
| Rate for Payer: Quartz Beloit One Network |
$584.08
|
| Rate for Payer: Quartz Commercial |
$774.80
|
| Rate for Payer: Quartz Medicare Advantage |
$715.20
|
| Rate for Payer: The Alliance Commercial |
$4,768.00
|
| Rate for Payer: WEA Trust Commercial |
$655.60
|
| Rate for Payer: WPS Commercial |
$882.91
|
|
|
STENT PERCUFLEX PLUS 4.8 X 28 M0061752540
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.08 |
| Max. Negotiated Rate |
$1,096.64 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.76
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,096.64
|
| Rate for Payer: Health EOS Commercial |
$1,060.88
|
| Rate for Payer: HFN Commercial |
$1,096.64
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: NAPHCARE Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.64
|
| Rate for Payer: Quartz Beloit One Network |
$584.08
|
| Rate for Payer: Quartz Commercial |
$715.20
|
| Rate for Payer: WEA Trust Commercial |
$655.60
|
| Rate for Payer: WPS Commercial |
$882.91
|
|
|
STENT PERCUFLEX PLUS 4.8 X 30 M0061752550
|
Facility
|
IP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.08 |
| Max. Negotiated Rate |
$1,096.64 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.76
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,096.64
|
| Rate for Payer: Health EOS Commercial |
$1,060.88
|
| Rate for Payer: HFN Commercial |
$1,096.64
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: NAPHCARE Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.64
|
| Rate for Payer: Quartz Beloit One Network |
$584.08
|
| Rate for Payer: Quartz Commercial |
$715.20
|
| Rate for Payer: WEA Trust Commercial |
$655.60
|
| Rate for Payer: WPS Commercial |
$882.91
|
|
|
STENT PERCUFLEX PLUS 4.8 X 30 M0061752550
|
Facility
|
OP
|
$1,192.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5685666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.76 |
| Max. Negotiated Rate |
$4,768.00 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.12
|
| Rate for Payer: Aetna Managed Medicare |
$333.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$774.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$572.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.76
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cigna Commercial |
$1,096.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.04
|
| Rate for Payer: Health EOS Commercial |
$1,060.88
|
| Rate for Payer: HFN Commercial |
$1,096.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$953.60
|
| Rate for Payer: NAPHCARE Commercial |
$715.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.64
|
| Rate for Payer: Quartz Beloit One Network |
$584.08
|
| Rate for Payer: Quartz Commercial |
$774.80
|
| Rate for Payer: Quartz Medicare Advantage |
$715.20
|
| Rate for Payer: The Alliance Commercial |
$4,768.00
|
| Rate for Payer: WEA Trust Commercial |
$655.60
|
| Rate for Payer: WPS Commercial |
$882.91
|
|
|
STENT PERCUFLEX PLUS 6 X 20 M0061752600
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 20 M0061752600
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 22 M0061752610
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 22 M0061752610
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 24 M0061752620
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 24 M0061752620
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 26 M0061752630
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 26 M0061752630
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 28 M0061752640
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 28 M0061752640
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 30 M0061752650
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 6 X 30 M0061752650
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
STENT PERCUFLEX PLUS 8 X 20 M0061752800
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4595201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$794.78 |
| Max. Negotiated Rate |
$1,492.24 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.66
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,492.24
|
| Rate for Payer: Health EOS Commercial |
$1,443.58
|
| Rate for Payer: HFN Commercial |
$1,492.24
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$973.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.24
|
| Rate for Payer: Quartz Beloit One Network |
$794.78
|
| Rate for Payer: Quartz Commercial |
$973.20
|
| Rate for Payer: WEA Trust Commercial |
$892.10
|
| Rate for Payer: WPS Commercial |
$1,201.42
|
|
|
STENT PERCUFLEX PLUS 8 X 20 M0061752800
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4595201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.16 |
| Max. Negotiated Rate |
$6,488.00 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.92
|
| Rate for Payer: Aetna Managed Medicare |
$454.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,054.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$811.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$778.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.66
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,492.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.67
|
| Rate for Payer: Health EOS Commercial |
$1,443.58
|
| Rate for Payer: HFN Commercial |
$1,492.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.50
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$973.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.24
|
| Rate for Payer: Quartz Beloit One Network |
$794.78
|
| Rate for Payer: Quartz Commercial |
$1,054.30
|
| Rate for Payer: Quartz Medicare Advantage |
$973.20
|
| Rate for Payer: The Alliance Commercial |
$6,488.00
|
| Rate for Payer: WEA Trust Commercial |
$892.10
|
| Rate for Payer: WPS Commercial |
$1,201.42
|
|
|
STENT PERCUFLEX PLUS 8 X 22 M0061752810
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4595301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$6,740.00 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.10
|
| Rate for Payer: Aetna Managed Medicare |
$471.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,095.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.93
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.75
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,095.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,011.00
|
| Rate for Payer: The Alliance Commercial |
$6,740.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
|
STENT PERCUFLEX PLUS 8 X 22 M0061752810
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4595301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.65 |
| Max. Negotiated Rate |
$1,550.20 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,011.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
|
STENT PERCUFLEX PLUS 8 X 24 M0061752820
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4595303
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.65 |
| Max. Negotiated Rate |
$1,550.20 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,011.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
